Abdel-Latif Mohamed, Mosbah Ahmed, El Bahnasawy Magdy S, Elsawy Essam, Shaaban Atallah A
Urology and Nephrology Center, Mansoura University, Egypt.
BJU Int. 2005 Aug;96(3):391-6. doi: 10.1111/j.1464-410X.2005.05637.x.
To assess prospectively the incidence with time of asymptomatic bacteriuria in patients with orthotopic ileal neobladders, and the possible effect on neobladder function.
In all, 47 patients (mean age 52.7 years, sd 8.7, range 31-68) with uncomplicated orthotopic ileal neobladders were prospectively evaluated. With no antibiotic manipulation, consecutive urine cultures were assessed monthly. Continence was assessed by direct information from the patients at each follow-up visit.
Overall, 797 samples were cultured from the 47 patients (mean 17.6, sd 7.1). There was a steady decrease in the incidence of positive cultures, from 74.5%, to 35.6% and 6.7% at 1, 6 and 18 months, respectively. While there was persistently sterile urine in only eight patients (17%), 32 had occasional and seven had persistent bacteriuria. Escherichia coli was the commonest organism (76.6%) followed by Klebsiella pneumonia (15.7%); 54% of E. coli and 38% of K. pneumonia infections were sensitive to nitrofurantoin. Diurnal continence was achieved in 98% of the patients at 6 months after surgery. There was a gradual decrease in the frequency of nocturnal enuresis (NE) with time, from 87%, to 42%, 28% and 27% at 1, 6, 12 and 18 months, respectively. There was a significant correlation between the presence of bacteriuria and NE during the first 6 months, but it was not sustained after that. The age of the patients was also related significantly to the incidence of NE; at 6 months, only one of 18 men aged < or = 50 years had NE, while 19 of 29 aged > 50 years had (P < 0.001). At 1 year all patients aged < or = 50 years were nocturnally continent, while half of those aged > 50 years had NE (P = 0.001).
Ileal neobladders are associated with a high incidence of asymptomatic bacteriuria during the first year after surgery. There was spontaneous clearance of bacteriuria with time, with no antimicrobial manipulation. Soon after surgery there was a significant association between bacteriuria and NE. The effect of antimicrobials on patients with NE should be evaluated.
前瞻性评估原位回肠新膀胱患者无症状菌尿的发生率及其随时间的变化情况，以及对新膀胱功能可能产生的影响。
对47例（平均年龄52.7岁，标准差8.7，年龄范围31 - 68岁）患有单纯性原位回肠新膀胱的患者进行前瞻性评估。在未使用抗生素干预的情况下，每月连续进行尿培养。每次随访时通过患者直接提供的信息评估控尿情况。
总体而言，对47例患者共培养了797份样本（平均17.6份，标准差7.1）。阳性培养率呈稳步下降趋势，在1个月、6个月和18个月时分别为74.5%、35.6%和6.7%。仅有8例患者（17%）尿液持续无菌，32例有偶尔菌尿，7例有持续性菌尿。大肠埃希菌是最常见的病原体（76.6%），其次是肺炎克雷伯菌（15.7%）；54%的大肠埃希菌感染和38%的肺炎克雷伯菌感染对呋喃妥因敏感。术后6个月时98%的患者实现了日间控尿。夜间遗尿（NE）的频率随时间逐渐下降，在1个月、6个月、12个月和18个月时分别为87%、42%、28%和27%。在最初6个月内，菌尿的存在与NE之间存在显著相关性，但此后不再持续。患者年龄也与NE的发生率显著相关；在6个月时，18例年龄≤50岁的男性中只有1例有NE，而29例年龄>50岁的男性中有19例有NE（P<0.001）。1年后，所有年龄≤50岁的患者夜间均能控尿，而年龄>50岁的患者中有一半有NE（P = 0.001）。
回肠新膀胱在术后第一年无症状菌尿的发生率较高。随着时间推移，菌尿会自发清除，无需抗菌干预。术后不久，菌尿与NE之间存在显著关联。应评估抗菌药物对有NE患者的影响。
